Provider Demographics
NPI:1467059790
Name:HUGHES, MIKALA PATRICIA
Entity Type:Individual
Prefix:MRS
First Name:MIKALA
Middle Name:PATRICIA
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 STADIUM RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2400
Mailing Address - Country:US
Mailing Address - Phone:386-254-1149
Mailing Address - Fax:
Practice Address - Street 1:420 STADIUM RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2400
Practice Address - Country:US
Practice Address - Phone:386-254-1149
Practice Address - Fax:386-254-1149
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008643363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner